Frago Ricardo, McDermott Frank, Campillo Beatriz, Kreisler Esther, Biondo Sebastiano
Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
Digestive Tract Pathology, IDIBELL, Barcelona, Spain.
ANZ J Surg. 2021 Jan;91(1-2):E25-E31. doi: 10.1111/ans.15876. Epub 2020 Apr 7.
Stage 2 colonic cancer comprises a heterogeneous group of patients with a spectrum of disease, from invasion of the sub-serosa to tumour perforation into visceral peritoneum/adjacent organs. This study evaluates the post-operative outcomes and prognostic factors of patients with both emergency and elective presentations of stage 2 colonic cancer treated with curative intent.
Retrospective analysis of a prospectively maintained database of adult patients (emergency and elective) who underwent curative surgery for stage 2 colonic cancer in a single tertiary referral centre between 2007 and 2016 was conducted. Multivariate analysis was performed to identify prognostic factors. Measured variables included demographics, complications, histology, disease-free survival and overall survival (OS).
A total of 428 patients with stage 2 colonic cancer received curative surgical resection, and negative resection margins were achieved in all cases: T3 group (stage 2A): 316 (73.8%); T4a group (stage 2B): 78 patients (18.2%); and T4b group (stage 2C): 34 (8%). There were 187 (45.7%) post-operative complications, 32 (7.5%) anastomotic leaks and eight (1.9%) 30-day mortalities. Eighty patients (19.3%) died during the follow-up. During the follow-up period, 45 patients developed recurrence (all distant). Multivariate analysis identified age >70 years, American Society of Anesthesiologists grades III-IV and male gender as factors associated with poor OS, while recurrence was higher in those aged over 70 years and with stages 2B-2C disease.
Surgical morbidity in patients with stage 2 colonic cancer who have undergone curative surgery is high. Older and more co-morbid patients have poorer OS. Stages 2B and 2C colon cancer patients have worse prognosis than those with stage 2A regarding recurrence. Future larger data sets are required to determine the role of transmural spread as a prognostic factor.
2期结肠癌患者群体异质性强，疾病范围从浆膜下侵犯到肿瘤穿孔至脏腹膜/相邻器官。本研究评估了接受根治性治疗的2期结肠癌急诊和择期手术患者的术后结局及预后因素。
对2007年至2016年期间在单一三级转诊中心接受2期结肠癌根治性手术的成年患者（急诊和择期）的前瞻性维护数据库进行回顾性分析。进行多变量分析以确定预后因素。测量的变量包括人口统计学、并发症、组织学、无病生存期和总生存期（OS）。
共有428例2期结肠癌患者接受了根治性手术切除，所有病例切缘均为阴性：T3组（2A期）：316例（73.8%）；T4a组（2B期）：78例（18.2%）；T4b组（2C期）：34例（8%）。术后并发症187例（45.7%），吻合口漏32例（7.5%），30天死亡率8例（1.9%）。80例患者（19.3%）在随访期间死亡。随访期间，45例患者出现复发（均为远处复发）。多变量分析确定年龄>70岁、美国麻醉医师协会分级III-IV级和男性为与OS不良相关的因素，而70岁以上患者以及2B-2C期疾病患者的复发率更高。
接受根治性手术的2期结肠癌患者手术并发症发生率高。年龄较大且合并症较多的患者OS较差。2B期和2C期结肠癌患者在复发方面的预后比2A期患者差。需要未来更大的数据集来确定壁层扩散作为预后因素的作用。
